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Grievance Process

A grievance is what you file when you are unhappy with a decision Community Care made about your behavioral health care. You can file a grievance if we:

• Deny a service
• Approve less of a service than your provider asked for
• Approve a different type of service than what your provider asked for

To file a grievance you can write out your grievance and mail it to us or call the Community Care office in your county. Your provider can help you file your grievance. If you want your provider’s help to file a grievance you need to give your provider permission in writing.

When you first file a grievance it is called a first level grievance. If after the first level grievance you still do not like our decision, you may file a second level grievance. If you disagree with the decision of the second level grievance, you can file your grievance with an agency outside of Community Care. This is called an external grievance. You have to go through the first and second level grievance process before filing an external grievance. At any time during the grievance process, you can request a Department of Public Welfare (DPW) fair hearing appeal.

If you would like more information about the grievance process please refer to your HealthChoices Member Handbook. You can also view the handbook on our website by clicking here and choosing the area you live in.

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